The Threat to Birth-Control Access in the Trump Era

The United States ranks behind most countries, even those where abortion is illegal, when it comes to the ability of women to purchase the pill over the counter.

Photograph by Drew Angerer / Getty

Last week, as Senate Republicans continued their attempt to repeal,
replace, or simply undermine the Affordable Care Act, the White House
moved forward with a plan to gut a provision that has been vital to protecting women’s reproductive rights. In addition to pursuing funding cuts to Title X, Planned Parenthood, Medicaid, and other programs that
provide women’s health services, particularly to low-income women, the
Administration is expected to amend the federal regulation that requires
employers to provide health-insurance plans that offer preventive care
and counselling—which the Department of Health and Human Services has interpreted to include contraception—at no cost. Currently, houses of worship, religiously affiliated colleges and hospitals, and certain
corporations can obtain an exemption from the requirement. But, according to a draft of an executive order leaked to Vox, the new
guideline, which is expected to be issued soon, would apparently
allow any business or organization to request an exemption on religious
or moral grounds. Gretchen Borchelt, the vice-president for reproductive rights and health
at the National Women’s Law Center, has said that hundreds of thousands of women could lose access to their birth control “if this broad-based, appalling, and discriminatory rule is made final.”

The foremost architects of the new rule—one that Donald Trump had promised on the campaign trail—are Katy Talento, a White House
domestic-policy aide who has claimed that birth-control pills “ruin your
uterus” and cause infertility, and Matthew Bowman, a lawyer at the
Department of Health and Human Services who fought the current rule (he
calls the birth-control pill the “abortion pill”) while working at a Christian legal-advocacy organization. The rule could sharply increase the onus of practical family planning for working-class and poor women; when not subsidized by insurance, the
price of a pack of birth-control pills can rise upward of a hundred dollars, and long-term, more effective methods, such as I.U.D.s, are initially even costlier. The White House is moving ahead with the change, even though the
Guttmacher Institute cites evidence that the use of contraceptives has contributed to the decline in the abortion rate, a trend that should be comforting to conservatives.

One count of women using insurance to buy birth control saw the number
increase by almost twenty per cent from 2014 to 2015. Yet the United States is behind most countries, even those where
abortion is illegal, when it comes to the ability of women to purchase
the pill over the counter. It’s an idea that many liberals and
conservatives can agree on—an effective contraceptive sold at
pharmacies, with provisions to provide it free to economically
disadvantaged women, would take the pressure off reluctant employers.
Opponents of the move say that there is room for misuse, such as not
taking the pill at the same time every day, missing days, or taking the
pills out of sequence, but, a few years ago, the American College of
Obstetricians and Gynecologists found that birth-control pills were safe enough to be sold over the counter. There has never been a significant move to do so, however, and there are still limitations on when women can buy birth-control pills even if they
have a prescription. A woman whose pack of pills is running low and who
needs to get another to cover her for, say, a period of travel abroad
could find herself unable to do so, because of common insurance rules
that determine how often women can obtain birth-control refills on an
already written prescription. She may be able to use a once-a-year
“exception,” but if she makes any further trips she may have to go off
the pill. Similarly, a woman whose ob-gyn usually writes her a year-long
prescription, until her next annual appointment, could find that,
through a move or a change of insurance plan, her new doctor will only
sign a prescription for six months, meaning that she will have to
schedule another appointment, and make another co-payment, to receive
more refills.

Economic concerns are just part of what a woman trying to exercise her
reproductive rights faces. Katrina Kimport, an associate professor in
the Department of Obstetrics, Gynecology, and Reproductive Sciences at the
University of California, San Francisco, analyzed fifty-two
contraceptive counselling visits that women had with their physicians
over three years. In a study she published this past spring,
Kimport wrote that the doctors mainly expected the women in a
heterosexual relationship to assume the “time, attention, and stress
that preventing pregnancy requires,” as opposed to their male partners’
having their own contraceptive counselling or exploring birth-control
options. Doctors viewed obtaining prescriptions, following a regimen, and watching out for side effects as the women’s expected duties—and theirs alone. The emotional and mental responsibilities that fall on women, Kimport
adds, further the gender inequality that created the initial imbalance.
If access to contraception becomes more difficult, women will assume the greater burden.

After the election last fall, there were reports of women rushing to
their doctors to get prescriptions for I.U.D.s, which can be effective
for several years—long enough to last them through the Trump Presidency.
Those women no longer seem so rash.

Under the southern portion of the city exists its negative image: a network of more than two hundred miles of galleries, rooms, and chambers.

As the years passed, Tom grew more entrenched in his homelessness. He was absorbed in lofty fantasies and private missions, aware of the basest necessities and the most transcendent abstractions, and almost nothing in between.